Jackson v. Segwick Claims Mgmt Serv., Inc., No. 10-1453 (6th Cir. 2012)Annotate this Case
Two former employees of Coca-Cola claim that they were injured while performing their jobs. They reported their injuries to Coca-Cola’s third-party administrator for worker’s compensation claims, Sedgwick, which denied benefits. Plaintiffs claim that the medical evidence strongly supported their injuries, but that Sedgwick engaged in a fraudulent scheme involving the mail: using Dr. Drouillard as a “cut-off” doctor. They sued alleging that the actions of Sedgwick, Coca-Cola, and Dr. Drouillard violated the Racketeer Influenced and Corrupt Organizations Act, 18 U.S.C. 1961(1)(B), 1962(c), and 1964(c). The district court dismissed. The Sixth Circuit reversed and remanded, noting that since the dismissal, several of the issues were resolved by its 2012 opinion in another case. The district court misapplied the elements of a RICO cause of action to the plaintiffs’ allegations. The court declined to abstain from exercising jurisdiction pending the outcome of state workers comp proceedings. The alleged acts have the same purpose: to reduce Coca-Cola’s payment obligations towards worker’s compensation benefits by fraudulently denying worker’s compensation benefits to which the employees are lawfully entitled. The allegations suggest that the defendants’ scheme would continue on well past the denial of any individual plaintiff’s benefits
The court issued a Revised version of this opinion on September 24, 2013.